Official accounts of improving healthcare in Afghanistan are hiding the reality of rising civilian casualties from fighting, and clinics that are too scattered and too poorly staffed for many people to reach them safely and in time, a new report says

LONDON (Thomson Reuters Foundation) - International aid has been poured into their country for more than a decade, but many Afghans must still navigate landmines, checkpoints or fighting to get to a hospital or clinic, a medical charity said.

Medecins Sans Frontieres (MSF), which has worked in Afghanistan since the early 1980s, said there had been some improvement in the country's healthcare system, but misleading stories of success ahead of the withdrawal of foreign troops this year were masking gaps in the quality and spread of treatment.

"I'm afraid the needs are going to increase with rising conflict and an increased number of people wounded or killed - and secondly, the response is going to decrease," MSF operations coordinator Renzo Fricke told Thomson Reuters Foundation.

Civilian casualties of fighting in Afghanistan rose by 14 percent last year, according to a U.N. report this month, which also showed 2013 was the worst year since 2009 for the number of women and children killed or wounded by fighting between government forces and Taliban insurgents.

MSF also said in its report that the number of people treated for wounds inflicted by weapons in Afghanistan rose 60 percent last year.

Reliable data on people's access to healthcare is hard to come by, but MSF interviews with more than 800 people in hospitals in Helmund, Kabul, Khost and Kunduz provinces revealed the deadly risks patients often take to get a baby delivered, a malnourished child treated or a wound patched up.

"It is remarkable how far the prevailing narratives of progress differ from the accounts of ordinary Afghans."

NO AMBULANCE, NO OXYGEN

A lack of money to pay for transport, long distances to the nearest health clinic, and insecurity were the three biggest barriers to getting healthcare, MSF said.

Patients spoke of watching over sick or injured relatives throughout the night, hoping they would survive until morning when it might be safe enough to venture out in search of treatment.

Others described clinics without enough drugs, qualified staff or electricity and people falling into debt to pay for treatment.

"After the fighting there are always six to 20 injured people who need medical help. But there's only one government hospital in the district, with no ambulance system to carry the wounded and no oxygen," MSF quoted a 21-year-old man living in Kabul as saying.

Four out of five people said they had bypassed their closest public health facility because of doubts about the quality of staff, services or treatment there.

Some patients said they had to bribe doctors to get treatment. “In the public clinic there is a lot of queue jumping and corruption,” a 33-year-old woman said.

The main providers of healthcare in Afghanistan, which has a population of around 30 million, are the government, international humanitarian groups like MSF and local charities.

"With the conflict spreading to once-stable areas of the country, and ominous indications that the war will only intensify in many places, along with lawlessness and displacement, the humanitarian situation in Afghanistan today cannot be overlooked," MSF said.